Friday, July 31, 2009

Thinking Outside the Box: Lessons in Military History, Part II

In Part I, we looked at how thinking outside the box enabled the Romans to defeat rival Carthage at its own game in the First Punic War. Instead of facing the vastly more experienced Carthaginian navy on their own terms, the newbie Romans figured out, in essence, how to stage a land battle at sea.

In Part II, we investigate a mirror opposite, how the American Revolution’s best general (on both sides) took on the British Royal Navy deep in the American wilderness.

The Battle of Valcour Island, 1776

Washington forced the British garrison out of Boston in the spring of 1776, but they returned with a vengeance several months later, with a huge fleet bearing a large army weighing anchor in New York and another armada sailing up the St Lawrence into Quebec.

The British had no problem routing Washington’s army just outside New York City and reducing it to a remnant as it occupied the city and asserted itself in New Jersey. In Canada, they easily swept aside the badly outnumbered Americans there. A British invasion from the north and into New York would bring a swift end to the ill-fated colonial rebellion.

One of the American commanders in Canada, Benedict Arnold, fought a brilliant delaying action, destroying British ships, fortifications, and sawmills as he retreated south.

The British Army followed to the northern shore of Lake Champlain, deep in what was then impenetrable wilderness, while the Americans regrouped on the southern end. This set the stage for one of the strangest campaigns in military history.

The key to transporting the British Army south to New York City was via the waterways, first Lake Champlain, then Lake George, then down the Hudson. But first the British needed to build a fleet, and so did the Americans, if they intended to stop the British.

The Americans had already commandeered a sloop or two, but were at a decided disadvantage, lacking the necessary shipwrights and sailors, as well as supplies and resources.

The British, in the meantime, came well prepared, with 10 prefabricated ships, plus a 180-ton warship that they took apart in Canada, carted overland, and reassembled on Lake Champlain, not to mention the necessary shipwrights to build more boats. By the end of the summer, the British had a fleet of 25 heavily-armed vessels, commanded by a captain of the Royal Navy, together with a full complement of officers and sailors.

More boats were equipped to transport 9,000 British Army regulars.

The Americans, under the leadership of Benedict Arnold, proved extremely resourceful in knocking out their own boats - some little more than wooden platforms - to bring their roster to 15. These were built by mostly carpenter labor, manned in large part by ragged soldiers turned sailors. Arnold was a general who happened to have experience as captain of his own merchant ship.

In mid-October, as the nearby mountains turned white with snow, Arnold headed north with his strange flotilla of 500 “sailors” to meet the British. His intention was to lure the British into the narrow rocky strip of water between Valcour Island and the western shore of Lake Champlain. Here, the British would have difficulty bringing their superior firepower and sailing skills to bear.

The disadvantage was the Americans were backed into a corner, with nowhere to run.

The inferior American fleet held up under a withering British bombardment at extremely close range, managing to inflict serious damage in the process, but as the sun set it was clear the day belonged to the British. Virtually every American boat was ready for salvage. The British, meanwhile, were sitting pretty with ships that had not yet joined battle.

Facing the certainty of total annihilation, Arnold effected a brilliant escape in the dead of night, but with the British in hot pursuit. Under hellish weather conditions, one ship was captured while others had to be scuttled. The remnants of his fleet managed to make it to a refuge, where the boats were torched.

Arnold succeeded in leading the 200 remaining men under his command overland to an American fortification at Crown Point, thence (with the Crown Point garrison) to Ticonderoga, where a large contingent of American irregulars were dug in.

After that, the only thing standing between the British advance down the Hudson (and inevitable victory) was the oncoming winter. It turned out in losing the battle, Arnold had in fact set the scene for winning the war. By forcing the enemy to engage in an arms race way out in the middle of nowhere and then join battle, Arnold had run out the clock, delaying the British offensive by a good three months.

The Brits' only option was to retire to winter quarters in Quebec and try again next spring. This bought the American cause a precious year, time for Washington to rebuild his ragtag remnant of an army into a highly-trained fighting force. Time to assemble a strong regular army on the northern front.

When the British attempted a second invasion a year later, the Americans were ready, with an overwhelming force at Saratoga. The outstanding commander in the field was Benedict Arnold.

Arnold’s extraordinary military achievement is a shining example of thinking outside the box, of reframing issues and coming up with solutions where none seemingly exist. Unfortunately, by shifting his allegiance to the British later in the war and thus betraying his country, Arnold is much better known as a sober object lesson in thinking far too far outside the box.

Thursday, July 30, 2009

Thinking Outside the Box: Lessons From Military History, Part I

Military history has a thing or two to teach us about life. Today’s and tomorrow’s two-part lesson involves thinking outside the box. Our case study focuses on two naval battles that took place two thousand years apart. The first was essentially a land battle fought on the water. The second a water battle fought deep inland.

The Battle of Mylae, 260 BC

The Western Mediterranean wasn’t big enough to accommodate two expanding superpowers. Rome was engaged in a land grab out from the Italian Peninsula while Carthage had a largely sea-based empire that extended up from North Africa into Spain and Sicily.

When the two finally butted heads in the First Punic War, it became evident that controlling the open seas was the key to victory. As inheritors of the Phoenician sailing tradition, Carthage had the decided advantage. Rome was faced with the prospect of building a fleet from scratch and then figuring out port from starboard.

They accomplished this in part by developing perhaps the first "simulators" in history, fabricating mock-up boats on land in which to train rowers and sailors.

Naval strategy of the day called for maneuvering one’s vessels into ramming and sinking the enemy ships. Rome’s survival depended on fighting naval battles on their own terms, which meant developing a strategy for fighting land battles at sea. Their solution was the corvus, a pivoting boarding device that hooked onto enemy ships.

The two fleets - about 130 ships on each side - met off of Mylae off the northern coast of Sicily. The Romans waited for the Carthaginians to initiate the action. When the enemy ships closed in, the Romans locked in their boarding devices and their soldiers swarmed aboard. The land battle at sea was joined.

The Carthaginians lost 50 ships and were forced to retreat. A succeeding battle resulted in further major losses.

In the end, the corvus proved a hazard in rough seas, forcing the Romans to adopt conventional naval tactics, but by this time they were real sailors.

By thinking outside the box - figuring out how to fight land battles at sea - the Romans accomplished the impossible, beating the highly favored Carthaginians at their own game, on their own “turf.”

To be continued ...

Next: The Battle of Valcour Island, 1776

Wednesday, July 29, 2009

The Asshole Effect

My most recent blog piece focused on the negativity people in my position attract. Call it the asshole effect. We’ve all had to deal with it. Knock on any door, these idiots are everywhere - people who hate Helen Keller, find fault in a sunset, and think cat food is fillet of cat, which they gleefully describe as tasting like chicken.

Their values are not our values. Hate thy neighbor, the Radioactive Plutonium Rule, It is better to receive than to give ... Whereas we struggle mightily trying to become better people, they cruise through life doing what comes naturally. Ironically - they are the miserable ones.

But it tends to be our friends and loved ones who hurt us most. From assholes, we know what to expect. From those close to us, the unexpected amounts to the unkindest cut of all.

Funny thing, a hundred individuals can heap praise on us - yet we vividly recall the one negative comment. Your dear friend throws himself in front of a car to save your life - you’re furious because three days ago he forgot your birthday.

What is it about us?

Today, by pure chance, I came across a blog piece on Psychology Today by self-described generalist, Jeremy Sherman PhD.

“We are all thin skinned,” he writes. “No one likes hearing anything that feels discouraging or critical. We don’t welcome news that feels like a setback, a loss of status, a loss of gained momentum. We find unpleasant anything that seems to say, ‘you missed a spot’ ..."

No surprise here. Here’s the eye-opener. Citing Jonah Lehrer, author of “How We Decide,” Dr Sherman documents how “loss aversion” contributes to irrational behavior: “Loss aversion explains why sustainable partnerships are ones in which positive encounters outweigh negative ones, five to one.”

Wait! Hold on! It takes FIVE positive encounters to offset ONE negative one? Apparently so. Not only that, any interaction only slightly ambiguous tends to get moved into the negative column. No wonder we’re so miserable.

I’m assuming Dr Sherman is talking about normal people. What about poor shmucks like us? We depressive types can’t seem to help it. We tend to give no weight to positive events and assign disproportionate value to the negative ones. Not only that, we tend to interpret neutral or only slightly encouraging events as negative.

So what does it take for us to balance the scales? A hundred positive events? No wonder we’re so miserable. Fortunately (I use the term loosely) I have bipolar. I have a tendency to over-react to good news. For instance, today I found out that a meteor did not fall on my head, and I’m ecstatic about that.

So what is going on here? Can we point to a system malfunction in the brain? Last month, at the Eighth International Conference on Bipolar Disorder in Pittsburgh, I came across a recent fMRI study that pinpointed a certain location in the brain that appears to be responsible for bipolars over-reacting to both reward and disappointment.

It’s as if we can’t turn our brains off.

The brain studies are coming in thick and fast. A lot of stuff is going on beneath the skull. Naturally, it’s easy - with our brains, especially - to interpret these findings as proof that we’re hard-wired for failure. Not necessarily. The brain is a work-in-progress and we can influence its development.

Granted, sometimes - often - it seems like we’re pushing a rock uphill. It helps if we have four muscular individuals in our scrum, shoulders to the boulder. But all it takes is one asshole, perched smugly above, with an extended pinky jabbing at our rock.

Screw you, asshole! This rock is running you over!

Monday, July 27, 2009

Comments You Don't Get to See

In my last blog piece, I recollected an unscheduled visit I had made to Walter Reed Army Hospital two years before. These are the type of spur-of-the-moment decisions journalists make all the time when they are on the road.

The purpose of my visit had been to see if I could get into the hospital’s psych unit to learn what was being done for returning soldiers with PTSD. Naturally - and appropriately - they did not let me in, Nevertheless, I made use of the visit in a blog I did for HealthCentral to draw awareness to PTSD.

“Time for quiet reflection on our heroes," I concluded in my piece. “Are they aware of what lies ahead for many of them? About the odium and contempt society will hold them in when it happens? These poor souls don’t have a clue.”

While there, I also encountered young men with missing limbs, which I also reported in my original piece.

At the moment, I am recovering from sciatica, which literally had me flat on my back for more than a week, I ventured out to the local diner last week, only to run into a telling reminder how fortunate I am: A woman at an adjacent table was relating to a neighbor about her husband, who had just had half his foot amputated.

That conversation prompted me to recall some of the suffering in my own family. Then those unforgettable images of those young men at Walter Reed seared through my conscious, with a pain far more intense than anything I had felt in my leg. Suddenly, my sciata didn't seem so bad.

Time to count my blessings. Time to come to terms with the natural process of aging. That was the theme of my most recent blog post here.

It seems “Anonymous” entirely missed the point:

“Let me get this straight,” he wrote. “You made an impulsive, spur-of-the-moment visit to Walter Reed Hospital, where you used the suffering of strangers to make yourself feel better?”

Even though I did not explain the purpose of my visit to Walter Reed in my last piece, it’s pretty obvious the reason wasn’t to make me feel better. But having already made up his mind, Anonymous wasn’t going to let a good tirade go to waste: “I bet they loved being an inspiration to you,” he concluded. “Some compassion, and admiration, for your aunt and cousin might have been warranted, rather than your self-serving, sanctimonious blather.”

Irrational attackers like Anonymous are an occupational hazard for all bloggers. They just happen, and when they try to post a comment, I simply hit the “Reject” button. There is no sense reasoning with them, as they are beyond reason. Typically, they have an antipsychiatry agenda, but a good many are just plain freelancers with anger issues. Here’s a doozy from a few months ago:

Keep popping those wonder drugs SAL aka McPimp {Oh, that's right, you don't do meds Mr. McPimp}. Maybe McPimp can get himself into see his other heros as in Biederman, Goodwin, Jamison, Nemeroff and all the other greed mongering bipolar child Pharma huggers!

Though McPimp is a pretty lame con-man; did you write that post yourself Johnny Boy aka Sal? Did you steal this Page from Herb of many faces and IDs play book? {making up people to talk at is an old trick for sociopaths like yourself}. I guess being a fraud isn't enough; now you make people up to have comments on your "LOST" adventure. You do know that plastic blow up dolls are next in your precarious relationship pattern. {laughing}

Let’s see: This version of Anonymous is confusing me with someone named Sal, is nursing a resentment with someone else named Herb and yet another individual who goes by the screen name ID, is entertaining a delusion that I’m not on meds (I’m on a very light dose mood stabilizer and have emergency meds on standby), that I fabricate imaginary characters, and that I’m part of the Pharma conspiracy.

I’m grateful to Phillip Dawdy of Furious Seasons, who acts as Jupiter to my planet earth. Namely, his gravitational field seems to attract all manner of space debris nursing cosmic resentments, some of whom have ideated physical violence against me. It helps when he makes up things about my personal life such as:

“Maybe that's why a little over two years ago, when I was making the Zyprexa documents available to the public and going up against Eli Lilly, McManamy was going on book tours, divorcing his wife who'd supported him while he wrote said book and moving off to the desert of San Diego County to find himself.”

That little piece of fiction drew a whole meteor shower of nutjob comments. Better they scar his planet rather than mine. But, occasionally one or two migrate into my orbit.

That’s what the “Reject” button is for.

Wednesday, July 22, 2009

How Lucky I Am

At ten last night, I plopped into bed exhausted, expecting sleep to overtake me. My sciata had other ideas. What was particularly depressing was I had been up and about that day, with recovery in plain sight. Now I had a possible major setback to contend with. It wasn’t till about four in morning that I was able to drop off into an approximation of sleep.

I literally had to force myself to get out of the house and go have breakfast and put on a happy face. Bantering with waitresses is part of my recovery bag of tricks. I managed to make a lame joke about adding a Coors Light to the coffee and orange juice and water that JoAnn, my other favorite waitress of all time, was bringing me.

Please, God. No setbacks please. I don’t know how much more of this I can take.

I was hoeing into my California omelette when I started paying attention to the conversation at the adjacent table:

A woman about my age was bringing a neighbor up to date on her husband. Half his foot had been amputated. It was touch and go. He had diabetes. He had been experiencing loss of feeling in his extremities for years. He’d had a major infection. He’d been on crutches for more than a year.

That wasn’t the end of the story. He’d had complications. A severe rash. Meds side effects. Plus stupid doctors. Emergency room visits. On and on, it went.

Diabetes runs in my family. My father mercifully died before doctors got a chance to amputate him piecemeal. He was a cripple the last six or seven years of his life. My younger cousin barely made it to age 40. The last time I saw her, my aunt was pushing her in a wheelchair. Her complexion was ashen gray and I didn’t recognize her.

Then I thought of a spur-of-the-moment visit I had made two years before when I was in Washington DC. “Walter Reed Hospital,” I said to the cab driver. I found my way to what appeared to be the main unit. A young man with no leg, with what appeared to be his family in tow, was being wheeled down a corridor.

I found my way to a smaller out of the way building. Young men - kids - in wheelchairs were enjoying the spring sun outside. Everyone of them had a missing limb. I approached the first one. “Hello, sir,” I said. “I’d like to shake your hand.”

I did this a number of times. Then I found my way to the lobby of a rec center and did it again.

I paused in a grove of trees. There I lost it. My body shook uncontrollably. Tears streamed down my face.

JoAnn came over to my table. “You know,” I said. “I can’t help but think how lucky I am.”

The sciatica? Nothing.

I returned home, still feeling pain, but in a rare state of transcendent contentment. I settled into a comfortable sitting position on the couch with my laptop, performing small chores, savoring my temporary splendid relationship with my universe.

For the heck of it, I pulled up an educational video I had done earlier this year. In one scene, I am running full tilt as I leap onto a small rock, which becomes the platform for a spectacular sub-orbital mission. The film freezes at the apogee of my ascent. The closing segment of the video opens on the same freeze frame, then shows me gracefully descending in slow motion. It is a beautiful sight.

I was 59 when I filmed that piece. I’ll be 60 in a few months. I joked to my daughter in an email two days ago that age is the biggest risk factor for everything that can go wrong with you. So don’t be stupid like me, I advised her - stay young.

I may or may not be able to attempt that kind of leap again, but it doesn’t matter. Age has its compensations. I will be a grandfather in a few months. Yesterday, my daughter emailed me a recent photo. She is a natural beauty, but now she radiated a special aura.

The sciata is a bitch, a taste of things to come. I’m entering the decade where things fall apart. But, right now, I’m okay with that. That could very well change tomorrow. But at this very moment, trust me, I have so much to feel lucky about.

Tuesday, July 21, 2009


As you know by now, three weeks ago I came back from a conference and a family visit with a bad leg cramp which turned out to be sciatica. Here’s what I left out:

My housemate Paul informed me we’d had two raccoon visitors. We live way out in the country, 3,500 feet up in the mountains. We get our fair share of four-legged visitors around here. Sometimes visitors with no legs.

It seems the raccoons had squeezed through the cat flap and had helped themselves to Bullwinkle’s cat food. Bullwinkle’s feeding station can best be described as a gravity-operated kibble silo. It seems that the raccoons had gotten in the habit of tipping over the plastic silo and helping themselves to several weeks of cat food.

I recalled just before my trip seeing evidence of their handiwork. I had attributed the effort to Bullwinkle, whose motive would have been my own negligence in failing to fill up the container.

But I was wrong! It was raccoons!

Can man outwit nature? We could close off the cat flap, but that would effectively make Bullwinkle a prisoner in her own home. Moreover, we would be conceding dominion to the interlopers.

Leave it to me, I assured Paul. I may only be a city boy, but I was up to the challenge.

I placed a metal coffee can which happened to have batteries in it on top of the feeder. Then I set an aluminum baseball bat atop the coffee can, with the top end leaning against the wall.

We know Bullwinkle won’t tip over the feeder, I explained to Paul. As for the raccoons ... I dropped the bat onto the entranceway concrete floor for effect.

The perfect booby trap. The noise would frighten away the raccoons.

In scientific terms, the amygdala, which mediates fear and arousal in the limbic system of the brain, would kick off the raccoons’ fight or flight response. The raccoons know they are encroaching on our territory, I explained to Paul, so their amygdalae will be on hair-trigger alert, Then we would just keep resetting the trap till the no-good bastards wised up.

A few days later, I drove forty miles out to the desert for my weekend water volleyball. My leg was still acting up, but I figured the pool exercise would be good for it, along with some good long soaks in the hot tub. Later that evening, I stopped in at my favorite eating spot, just a mile from the Mexican border. It was Sunday. The July Fourth weekend was wrapping up, business was dead, and it was just me and one other customer in the place.

Plenty of time to chat with Michelle, my favorite waitress of all time. Michelle is a genuine mountain girl, who grew up 10 or 12 miles from where I now live. Maybe she had some insights into raccoons.

In the place where she used to live, she related, she heard an unworldly banging noise in the middle of the night. The racket was far too loud to come from a mere animal, she figured. It had to be a human intruder.

“So I grabbed my shotgun,” she said in the same casual voice a city girl would use to describe choosing a Versace handbag. “And I was holding the barrel in the same hand as my flashlight.”

She entered the garage-basement ...

A giant raccoon was splayed on the top of a garbage can, trying to undo the clasps holding down the lid. With each effort, the raccoon would literally lift the container off the ground and crash it to the hard concrete.

Never rule out the resourcefulness of a mountain girl. Michelle found a high vantage point over the raccoon, loaded, and ...

Emptied a container of her own freshly-minted piss on the critter.

“Never saw the raccoon again,” she told me with a smile.

Michelle also advised me that she employs the piss option to keep the coyotes away. Literally, she flings the stuff into the bushes and the trees. That way, her cats stay safe.

It’s all about the cats.

I returned home and set my canvas bag on the table, and decided to call it a night.


One in the morning. I opened the door to investigate. The cat feeder was down. No raccoons in sight.

Man vs nature. Score Round One to man. With great satisfaction, I reset my booby trap and went back to bed. Bring it on, heh-heh-heh ...

At four in the morning, I heard a scratching sound from outside the bedroom door. Bullwinkle was asleep with me. It had to be the raccoons making a return visit. I braced myself, awaiting the inevitable crash ...

No crash.

Scatch-scratch-scratch ... Something was wrong. The raccoons were mocking me, holding a raccoon party, here, in my own territory. The nerve! Calmly, cooly, I reached in the dark for my nearest Gutenberg Bible and threw it against the bedroom door. Instantly, from outside, came the sound of a flapping cat door and the skittering of mother nature’s furry psychopaths in full retreat.

I reassured Bullwinkle, and psychically instructed her to stay put. Then I went out to investigate. The cat feeder was untouched. But my canvas bag was off the table and on the floor, half-way to the cat flap. Inside was the prize, one microsecond from being unprized - half a leftover tuna sandwich.

The raccoons had wised up alright. Score Round Two to nature.

Speaking of nature, nature called. Now it was my turn to wise up. I found a plastic cup and aimed. Then I went outside and scattered the contents outside the door and immediate environs. Then I reloaded and marked my territory further afield.

That was more than two weeks ago. The raccoons haven’t been back since. This, despite the fact that my worsening sciatica rendered me virtually defenseless to future furry onslaughts. As I triumphantly explained to Michelle, mountain girl extraordinaire, it’s a good thing I’m an alpha male - otherwise the raccoons would have laughed at my piss.

Let that appear on my gravestone: “Raccoons respected his piss.”

Monday, July 20, 2009

Bad Pain, Good News

As you know, I spent the last week lying flat on my back on the couch, breathing through sciatic pain, looking up at the spinning ceiling fan. My one bright spot during the week was an email from a site called Online College informing me that “Knowledge is Necessity” was included in their 100 Powerful Blogs for Self-Improvement.

According to Online College, the blogs “can help you achieve your goals, learn new skills, become a better parent, and expand your knowledge of the world around you.”

The list include blogs from a wide array of categories, from Personal Development to Art and Culture to the Environment to Travel, plus more. “Knowledge is Necessity” is one of 10 health and wellness blogs on the list, and the only mental health blog.

Had I started this blog at the end of 2007 rather than 2008, I probably would have called it something like “McMan’s Depression and Bipolar Blog” as a companion to my “McMan’s Depression and Bipolar Report” and “McMan’s Depression and Bipolar Web,” which I had been doing since 1999 and 2002, respectively.

But over time, my quest for understanding my illness (bipolar) has morphed into a quest of rigorous self-enquiry that embraces all of mental health and the wider world around it. “Knowledge is Necessity,” is the name I came up with to best demonstrate this new outlook, oddly the tag line I had been using since I first got started in 1999.

Thus, I find it gratifying to receive a pat on the back for charting a new course, just seven months into the effort.

Nevertheless, my guiding principles are the same ones I started out with back in 1999, namely that everything I write is aimed at either providing insight into how we tick (and tock) or helping us manage the challenges that life happens to throw our way. In short, it’s all about YOU, the individual, and those who love you.

This applies even when I am recounting my own experiences.

Back to couches and ceiling fans. I was squinting at my laptop, which I was holding with two hands above my head. Ah! Good news. Glad tidings have the power to lift us above our pain. But - the pain always comes back, reminding us how truly mortal we are.

Wisdom transforms us, transcends us. But it is pain that makes us wiser. I’m flat on my back, yet moving forward. That’s the way it is, always was.

Sunday, July 19, 2009

Shoot For the Moon

Fortieth anniversary: July 20, 1969.

Friday, July 17, 2009

Walter Cronkite - And That's the Way It Was, 1916-2009

I don't have too many heroes. He was one of them.

Quick Update

I've had two visits to a chiropractor and am starting to feel some improvement. I won't be break dancing anytime soon, but I'm looking forward to being back to blogging in the next day or two. Many thanks to all of you who have expressed your support. Till then ...

Addendum: For a more complete account of my last week, check out my BipolarConnect blog post, A Week I Would Rather Forget.

Wednesday, July 15, 2009

Taking a Break

I'vv been dealing with sciatica the last two weeks. The past several days the pain has been intense. So - until the pain dies down ...

Friday, July 10, 2009

Earth to Psychiatry: Let Patients Smoke

Susan's When You're Going Through Hell Keep Going blog comments on a Newark (NJ) Star-Ledger item that reports:

"Beginning today, smoking will be banned in all areas of the Greystone Park and Ancora psychiatric hospitals, with similar bans to follow at three other state psychiatric facilities ..."

Smoking is already prohibited inside all state psychiatric hospitals in New Jersey. Says Susan:

"I would like to know what genius convinced Governor Corzine this is a good thing. They sure as hell didn't ask me. I have been in private and public hospitals - and what do you do in them? You smoke."

Susan goes on to say:

The last time I was in a hospital, the smokers were going off the wall, craving their cigarettes. The nurses were giving them patches, but the thing is about a patch, you want something to hold in your fingers, to put in your mouth, to shake into an ashtray, to grind the butt down. It's not just the process of lighting the cigarette, putting it to your lips and inhaling, it's everything.

Take it away from people in psychiatric hospitals, what do you get? A bunch of unhappy smokers who are forced against their will to wear patches and crave a cigarette. They get unhappy. They snap at the doctors, and nurses. They are miserable, crabby, and just not pleasant to be around.

According to the Star-Ledger article, the ban was instituted in the name of "wellness and recovery." According to an official, quoted in the article: "Our intent is to increase the life-spans of our patients, not to shorten them."

Ahem. Excuse me. I have a friend here in California. Last year, hospital staff picked a fight with her brother, Jeffrey, age 25, over whether he could have a cigarette break. Staff decided to show him who was boss. He was placed in five-point restraints, belly down, where he died.

Earth to psychiatry: Let patients smoke.

Individuals are admitted to psychiatric facilities in a state of crisis, generally in extreme agitation and often traumatized by a very recent event. They find themselves - usually against their will - in a strange environment that they rightly perceive as threatening.

Locked units with buzzing doors, strange people, police walking in and out, uniformed security, burly men poised for a takedown ...

So what do authorities do? They take away the patient's one comfort, the one thing that may help them settle into their new environment.

Psychiatric hospitals exist to take an individual out of crisis and move him or her into a state of conditional stability before sending them back out into the street, typically disoriented and confused. Patients don't get "well" in these settings. But they need all the help in the world getting them through the experience.

How misguided is psychiatry? The same profession that purports to be concerned about the patient's long term health when it comes to nicotine is the same profession that puts them on meds that demonstrably shorten their life spans over the long term.

Sorry for raving, but this hypocrisy bugs the hell out of me.

Last year I was in New Jersey, giving a ground rounds lecture at a private psychiatric facility in Princeton. No Smoking signs were all over the grounds. My talk was on meds compliance, and part of my prepared message included the fact that as opposed to the low compliance rates for meds over the long term (because they leave an awful lot to be desired), tobacco has a 100 percent compliance rate (because it works).

One reason that most people with schizophrenia and bipolar crave cigarettes is because for the brief time a cloud is in their lungs, their head clears up. People with schizophrenia in particular have difficulty filtering out distractions, which interferes with their ability to think. This changes when nicotine molecules lock onto the neuron's alpha-7 nicotinic receptors.

In the drug development pipeline are nicotinic agonists.

Patients are sending a message loud and clear, I told the psychiatrists and therapists in the audience. They will take a drug that works, even one with the worst side effects profile in the world.

I happened to jokingly add that maybe they should be prescribing cigarettes to their patients. I also called them out over the No Smoking signs I saw on the hospital grounds.

My audience showed their appreciation by emptying the room as soon as my lips stopped moving.

Psychiatrists I have talked to in private also don't get it. They have been conditioned to believe that smoking is a bad thing - which it is - that should not be encouraged. They forget that there is a crucial distinction between short-term and long-term treatment. Getting a person out of crisis is not the time to be worrying about what may or may not occur a quarter century from now. That's why doctors overmedicate with drugs that are blatant metabolic and diabetes risks. That's why patients should be allowed to smoke.

You don't facilitate getting a patient through a crisis and moving toward stability by taking their one security blanket from them.

(Recovery Innovations, based in Arizona, seems to be the one exception. At the emergency facility they operate in Phoenix, they have a policy of zero restraints. Significantly, they allow patients to smoke.)

Long-term care is a different kettle of fish. You leave the patient on high side effects meds only if you have to. You promote good diet, exercise, and all the rest. If the patient is smoking, you encourage various smoking-cessation regimens, when the patient is ready.

Sorry for raving on. I never smoked. I hate idiots who think they have a First Amendment right to blow fumes in my face. But what I hate worse is innocent people dying alone in five-point restraints, all because of an argument over a cigarette.

If Jeffrey had been allowed to have his smoke, he would be alive right now.

Thursday, July 9, 2009

Age Six with Schizophrenia

Michael Schofield takes his six-year old girl, Jani, to Denny's. So far, so good. Then orange juice spills onto her lap. Oh crap. As Michael recalls in his extraordinary blog, JanuaryFirst:

Jani screamed and began pulling at her pants like they were on fire. My immediate thought was "oh shit, we are in a public place." I hadn't bothered to check if Jani had properly dressed herself and too late I realized she had no underwear on.

Jani has been diagnosed with schizophrenia, which usually breaks out in late teenhood-early adulthood, nearly always preceded by years of strange and erratic (and often brilliant) behaviors. From the very beginning, Jani hardly needed to sleep. At age 3, the tantrums began. At age 4, her IQ was tested at 146 (genius level). At age 5, her rages became violent.

In his blog, Michael admits to both he and his wife Susan striking back, as well as taking away her toys and even "starving" her. The antipsychiatry community, ignoring everything else, jumped all over this as the true cause of Jani's condition.

Meanwhile, Jani's one or two invisible friends expanded into a psychotic community, along with hallucinations and delusions. Attempts at kindergarten and first grade failed. Last fall Jani tried to jump off a second story balcony. Autism? Bipolar? Doctors had no answers. Earlier this year, a medical team at UCLA issued their verdict - schizophrenia.

Meanwhile, back at Denny's:

Jani was crying and screaming that she had to get her pants off and I was trying to hold on to them so she couldn't get them completely off. Because if she got them completely off her legs would be free and I would get kicked in the face as I tried to put them back on, she would scream and run out of the restaurant, exposed to the world. I would be then forced to chase down my half naked daughter until the cops arrived and arrested me (what other conclusion could they draw other than I was trying to molest my daughter over a Grand Slam at the local Denny's?).

At last count, Jani has been hospitalized four times, and is being tried on different meds with bad side effects, which frightens the hell out of her father. The type of social services available to older patients with schizophrenia are not available to Jani. Pediatric residential facilities want nothing to do with a kid with the scariest diagnosis in the world. Right now, Michael and Susan are renting two one-bedroom apartments in the same complex. One parent stays with Jani while the other one (with their younger son) gets a break.

On Sunday, Michael posted, Hopefully, This Will Be Jani One Day, with a link to the biography of Elyn Saks. Elyn Saks is the author of the highly-acclaimed "The Center Cannot Hold," which documents her struggles with schizophrenia and her road to conditional recovery. Elyn Saks holds a masters in philosophy from Oxford, is a professor of law at USC, and is on the verge of attaining a qualification in psychoanalysis.

Says Michael: "Saks’s story gives me hope that one day Jani will be able to tell her own story."


Michael's JanuaryFirst blog represents the most compelling reading on mental illness I have encountered anywhere, online or off. Also, check out this LA Times piece on Jani, plus this one on childhood-onset schizophrenia.

Wednesday, July 8, 2009

Extreme Idiocy in the Media

Katherine Stone writes a terrific blog, PostPartum Progress, which is undeniably the best source of information on postpartum mental illness anywhere, online or off. The other day, she referred me to a Vanity Fair piece that Todd Purdun wrote about Sarah Palin. Here's Katherine's take:

I just LOVE it when pundits and politicians talk about postpartum depression. In the latest issue of the magazine Vanity Fair, Todd Purdum writes this in his article on former Vice Presidential candidate Governor Sarah Palin and the 2008 Presidential campaign:

"Some top aides worried about her mental state: was it possible that she was experiencing postpartum depression? (Palin's youngest son was less than six months old.)"

Purdum doesn't go into why Palin's aides would have thought that. In the paragraph in which he refers to postpartum depression, his only explanation is that Palin was doing what she wanted to, rather than following the campaign's direction, and was "maintaining only the barest level of civil discourse" with certain handlers. ...

Katherine points out that PPD is NOT about being able to get along with others. (Otherwise, I hasten to add, men would qualify for PPD, as well.) As Katherine notes, the article would have been believable had Gov Palin, among other things, been "wondering how on earth she could get through the next five minutes and even possibly considering suicide."

In which case, we might expect a show of sympathy and concern from the author (Ha!). Instead, Purdun piles it on by recklessly applying the diagnosis of narcissistic personality disorder to the epithets "erratic" and "whack job."

Unfortunately, Vanity Fair is to journalism what Caspian beluga is to caviar.

It turns out that Katherine caught me at a time when I'm less than upbeat about my own profession. Seven months ago, I took out membership in the Association of Health Care Journalists. A few months ago, I also made a donation. My general belief is that journalists "get" mental illness, but something happened last month that strongly challenged that notion:

The AHCJ maintains a listserve, which is mostly devoted to inquiries by reporters looking for leads on various stories, but which is also used for dialogues on issues germane to our profession. In response to a Newsweek cover story that was highly critical of Oprah and the irresponsible "wacky cures" she featured on her show (see my blog post), I posted this question to the list:

"Opinions, anyone?"

A first gatekeeper to the list, Jeff, responded that I needed to be more specific. Okay:

Two years ago, Oprah had devoted an entire show to "Did Bipolar Drive a Mother to Kill Her Child?" The show was as appalling as the title.

My opinion: Oprah is an unmitigated idiot, a menace to society, and the antithesis of everything we stand for as health journalists. I'm delighted a major news outlet finally had the guts to call her out. I would be very interested in your take on the Newsweek article, your own Oprah experiences and impressions, and your views in general.

Also: Should AHCJ take a position?

A second gatekeeper, Ivan, dressed me down for my ad hominem remarks. Fair enough. Out they went. Then Ivan responded that he would "mull" over whether he would post the piece. Apparently, I was not being specific enough.

This is a small sample of my response:

"Ivan, this is your listserve and your rules, but as a member of the AHCJ and a donor I take strong objection to your officious attitude regarding my posts. ..."

Following, in part, was Ivan's reply:

"I have shared your rewritten posts with board colleagues, and we continue to have concerns. ... Your post remains vague and does not include any specifics about what you found objectionable about the Oprah episode you cite, nor about the Newsweek piece."

Okay, let me see if I got this right. I wrote: "Two years ago, Oprah had devoted an entire show to 'Did Bipolar Drive a Mother to Kill Her Child?' The show was as appalling as the title."

That wasn't specific enough to Ivan and AHCJ board members. Hmm. "The show was as appalling as the title." Could it be that they found nothing appalling about the title? That Oprah making our population out to be baby-killers was somehow - okay?

Let's just change one word so we get: "Did being African-American Drive a Mother to Kill Her Child?"

Or perhaps this: "Did being Lesbian Drive a Mother to Kill Her Child?"

Would that have been specific enough for Ivan and the AHCJ board members?

I was going to reply to that effect, then I decided I would be wasting my time. I will be allowing my membership in the ACHJ to lapse and won't be making any more donations. I have a very low tolerance for idiots, especially ones that practice my profession.

Katherine Stone apparently feels the same way. This is how she ends her blog piece:

"Despite my complete lack of psychiatric training, I feel very confident in giving Purdum and his editors at Vanity Fair this diagnosis: They are a bunch of idiots."

Tuesday, July 7, 2009

The Brain is an Ecosystem

Moira writes:

"We're being told by experts to quit describing mood disorders as chemical imbalances. What metaphor or analogy shall we deploy to replace chemical imbalance?"

Moira was responding to a piece I posted from a bipolar conference a couple of weeks ago where I had this to report: "We're not talking 'imbalance of chemicals of the brain,' Dr Manji reminded his audience. Instead, think of mood disorders as 'impairments of synaptic and neural plasticity.'"

What this means is that instead of conceptualizing the brain as some sort of uniform chemical soup that could use a bit more serotonin or dopamine, we need to see the brain as a highly intricate ecosystem that requires sophisticated nurture and cultivation. In a guest blog post here, Cristina Romero had this to report from a talk by Kay Jamison:

"The brain is like a pond. It’s like an ecosystem. You want to get the ideal ecosystem and then you don’t want to disturb it very much. ... You want to really create a stable environment."

The brain, like an ecosystem, is highly complex, non-linear, and self-organizing. Both brain scientists and environmentalists describe this self-organizing principle as "homeostasis," where the system maintains its own equilibrium at a particular "set point." Robert Sapolsky in "Why Zebras Don't Get Ulcers" gives the example of perspiration to regulate body temperature.

But what if we're in the desert? If we keep perspiring, we will lose water and die. Here's where "allostasis" kicks in: We stop sweating buckets, our mucus dries up. Once the crisis is over, our body reverts to normal, or - in response to changing circumstances - it may find a new set point.

With "allostatic overload," we are talking system breakdown, such as what may happen with global warming or what is going on right now with the current economic-financial crisis. Allostatic overload is what happens to us when our brains fail to cope. Those of us with mental illness reach overload fairly quickly. When this happens, our brains simply don't reset to normal. We find ourselves caught in a destructive dynamic, trapped in our thoughts and emotions.

Ecosystems operate on "macro" and "micro" levels. This corresponds to the "impairments of synaptic and neural plasticity" that Dr Manji was talking about. Until recent advances in brain imaging and gene technology, we had a vague macro idea of neurotransmitter traffic, which gave rise to the "monoamine hypothesis" to explain mood disorders and other mental illnesses.

A gross oversimplification of this hypothesis resulted in the "chemical imbalance" myth of mental illness, best illustrated in the Zoloft ad below:

Of course, as Dr Sapolsky mentioned in an educational video, the brain is not "undifferentiated tofu." A serotonin or dopamine lube job is is not going to have the same uniform result in different areas of the brain.

Below is a far more sophisticated macro view of the brain:

In the fMRI image, we can view how one particular pathway between two different areas of the brain is supposed to operate when things are going right. When things go wrong, that narrow arrow on the right becomes wide.

The arrows represent neurotransmitter traffic, busy and focused on the left, light and broken up on the right. Too much traffic on the right means the emotional part of the brain is dominating the conversation with the rational part of the brain, which happens a lot of the time to those of us with bipolar.

Think of this macro view as the brain working (or not working) on a "systems level." The "cellular level" represents the micro view. Recall "Nerve A" and "Nerve B" from the Zoloft ad. They were largely empty. Here's an approximation of what is really going on inside the neuron:

When things go wrong inside, the neuron may shrivel and even die. On a macro level, when neurons go off-line and fail to communicate (via neurotransmitters) with other neurons, entire brain systems are compromised. We lose our ability to think and function.

As you can guess, "macro" and "micro" are interconnected. Each regulates the other in highly intricate and virtually infinite ways. When things go right, we can only marvel at this creation of nature. When things go wrong, it's not just a chemical imbalance - it's a catastrophe, a collapse. Think "ecosystem."

Much more in future blog posts ...

Further reading

Check out the Science section to mcmanweb. A sample:

"By learning what happens after dopamine binds to its target neuron, we have been able to behold the brain’s inner watch works and marvel over its elegant complexity. This, in turn, is adding to our understanding of the outer watch works, namely how different parts of the brain talk to each other and how various neurotransmitter systems interact."

Monday, July 6, 2009

No Hope - Where Hope Truly Starts

"How hopeful are you?" I asked you - my readers - over the month of July. Of the 168 who responded, one in four of you (25%, 42) told me that you "see little or no hope in the way my life is going." By contrast, a mere one in ten (10%, 17) felt "very optimistic about my prospects."

Fortunately, another one in four of you (27%, 47) owned up to being "cautiously optimistic about my future." Still, that adds up to less than 4 in ten who are upbeat about the way your lives are going.

Over at the other end, more than one in ten of you (14%, 25) are fearful about tomorrow. Combine this with the "no hope" group, and we're pretty evenly balanced between the "upbeats" (37%) and the "downbeats" (39%).

Occupying the middle are one in five of you (22%, 25) who are "living day to day."

What are we to make of all this? Without hope, we can pretty well kiss recovery goodbye. But we also know that hope is a non-starter in the midst of a raging depression or similar mental illness state. Perhaps I simply caught some of you at a bad time.

But for many of you, the current state of your illness may have little or nothing to do with it. Your episode may have resolved, but the personal fall-out hasn't. Plugging your life back in is simply not going to happen with no job to go back to, no friends, no loving relationship, no money in the bank.

On top of everything, we are in the midst of the worst economic/financial crisis in memory.

Well meaning people, including therapists, are bound to point out the error in your thinking, but I would rather congratulate you for acknowledging the truth, for owning up to how you feel right now. Yes, we all want hope in our lives, but false hope is a mirage. Once we accept reality, we can work our way to understanding, and - eventually - true wellness. Hold that thought - this is where hope begins ...

Sunday, July 5, 2009

Where's Bullwinkle?

This is a story about my cat, Bullwinkle, but the story begins days earlier, in a different time zone:

Last week, on a family visit to CT, my brother and I walked ten miles along the Farmington River. I did fine for the first nine miles, but by the time we got back to the car my leg was cramping up. I woke up the next morning in severe pain, initially unable to maneuver my way out of bed.

I spent the rest of the day alternatively lying on a heating pad, stretching, and trying to walk out the cramp.

I felt somewhat better the next day, but I was scheduled to fly back to CA in the afternoon. Six hours jammed into a plane seat, I knew, was the worst thing I could do for my leg, and my prophecy proved correct. By the time I touched down late Wednesday evening in San Diego, my leg was both vibrating like a tuning fork and aching like a bad tooth.

Here's where Bullwinkle comes into the picture. I arrived home with no cat to greet me. According to my housemate Paul, she had gone AWOL two days earlier. We are 3,500 feet up in the mountains, and not all the animals are friendly.

Then again, I figured, Bullwinkle was bound to materialize once she sniffed my presence. For some reason, Bullwinkle thinks I'm her mother. Paul, on the other hand, is just a human interloper.

Next day, no Bullwinkle. Now I knew something was wrong. Meanwhile, I was happy to donate my leg to science, provided they were willing to take delivery of it immediately.

Friday morning, still no Bullwinkle. Then - from somewhere in the distance - meow-meow-meow. Bullwinkle? The neighbors to one side have a cat who likes to wander in and help himself to the food here. The neighbors to the other side recently acquired two indoor cats.

I decided to go outside to investigate, but first I needed to don a pair of sweat pants. I stood on my foot (the one attached to my good leg) as I aimed the other toward the appropriate opening as best I could. A blinding pain shot in both directions from the sole of my foot to my buttocks.

I breathed through the pain as best as I could, only to find my leg had gone astray and that I was en route to putting my pants on backwards. Eventually, I got myself organized and limped out the door, first up a flight of concrete steps outside, then down.

Meow-meow. Muffled meows. Where were they coming from? Inside the neighbor's house? The roof? the back yard? The garage-basement? No Bullwinkle. Had to be the one of the neighborhood cats.

Indoors, I went, defeated. But the muffled meows continued to haunt me. Then I thought I heard a real one, right outside the door this time. Bullwinkle? "Hey, Little Guy," I called, half-expecting the fur ball to appear through the cat door.

Nothing doing. Outside again I went. Faint but persistent meow-meows. But where were they coming from? Each time I felt I was approaching the source, the meows would disappear, only to start up again from a different and distant spot.

Then, the meows stayed put. They were coming from the ceiling area inside the garage-basement. Once again, I made my way inside. The meows were now coming in loud and clear. From a recess between the wall and ceiling poked a forlorn and furry face.



Before I knew it, I was up a ladder, with the poor guy in my arms.

It's now Sunday morning. The little critter has barely left my side. My leg still hurts like hell, but you know what? - for those ten or twenty seconds I was on the ladder I didn't feel a thing.

Saturday, July 4, 2009

This Fourth of July ...

Our Founding Fathers were a highly fractious bunch with radically different visions of what a United States of America should look like, but the one thing they had in common - they were smart. Dumb was not going to cut it. Check out the names: Adams, Franklin, Jefferson ...

George Washington, who was putting together an army outside of Boston at the time the Declaration of Independence was ratified, was acutely conscious of the fact that he lacked both the intellect and polish of his contemporaries gathered in Philadelphia, but possessed the wisdom and humility to know his place.

Washington not only respected smart, he nurtured his own whiz kids, including the brilliant field generals Nathaniel Greene and Benedict Arnold (the best general on both sides), and aide de camp Alexander Hamilton, who would later mastermind his highly successful Presidency.

Virtually all of the mess we are in today can be attributed to dumb and the culture of dumb. Where smart does exist, we have tended to squander this rare and precious resource in pursuit of dumb agendas. Only smart in the service of smart is going to bail us out of the state we find ourselves in today. Dumb is not going to cut it.

This Fourth of July ...

Let's remember what this country was truly founded on. Let's celebrate smart.

Friday, July 3, 2009

Rerun - Making Peace With Our Families and Loved Ones

Taking a brief break from work. Following is a rerun of a piece I posted in Jan:

At least half of the correspondence I get from readers comes from loved ones, including family members and sweethearts. Without exception, they are at a loss and their stories are heart-breaking. They are the innocent bystanders of our illness.

I've also had ample opportunity to listen to loved ones at various mental health venues, plus I am forever engaging them (or, rather, they are engaging me) in conversations in coffee shops, on public transport, everywhere. More recently, by virtue of a broken marriage to a woman with bipolar, I've have had an opportunity to sit in with a DBSA-run friends and family support group.

Believe me, our loved ones see our illness far differently than we do. We may complain that they don't understand us, but far too many of us fail to recognize the horrible abuse we have put them through.

Believe me, to live with a person with a mental illness is to live in an abusive relationship. Until we own up to this hard cold truth, we will never make peace with ourselves and our loved ones. We will always be stuck in our recovery, perpetual victims, always finding fault in the people who love us, always blaming our outrageous behavior - illness-related or not - on our illness.

I cannot disclose what takes place in our friends and families group, but I can mention this much: A father was in tears, at the end of his rope. I felt I needed to jump in, but as a patient. We put you through hell, I said, or words to that effect. But you are the best thing we have going for us. We can't do it without you ...

I noticed the look on his face. I noticed the others in the room were listening intently. No doubt, they had heard this before, but from fellow family members. What made my little homily significant was that this time the words were coming out of the mouth of a patient.

At last, came the thought, someone who understands.

Understanding. Isn't that what we are all looking for?

Much more in future blogs, including what loved ones need to know about us ...

Wednesday, July 1, 2009

Homeward Bound

It’s 2:45 PM. I’m at Hartford-Springfield Airport. In a half-hour I board for Baltimore-Washington, thence to San Diego. I’ll arrive in San Diego late evening Pacific Time, then head 40 miles east and 3,500 feet up where I expect to fall asleep in my own bed some time around midnight.

I’ve been on the road for a week, first to a bipolar conference in Pittsburgh, then a family visit in central CT. Tomorrow I expect to spend the day doing nothing. Ahh, nice thought.

For now, over and out ...